| Name: | GOODWIN MEDICAL CLINIC, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Oct 2015 (9 years ago) (Companies founded in October 2015) |
| Entity Number: | 000-346-000 |
| Register Number: | 000346000 |
| ZIP code: | 35901 (Companies in Etowah, 35901) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Registered Office Street Address: | 431 S 3RD STREETGADSDEN, AL 35901 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841662020 | 2015-10-27 | 2016-02-24 | 431 S 3RD ST, GADSDEN, AL, 359015210, US | 431 S 3RD ST, GADSDEN, AL, 359015210, US | |||||||||||||||||||||||||||
|
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| Phone | +1 256-547-0433 |
| Fax | 2565470460 |
Authorized person
| Name | DR. JEREMY DALTON GOODWIN |
| Role | OWNER/ SOLE MEMBER OF LLC |
| Phone | 2565470433 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 24747 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE GROUP PTAN |
| Number | 10270G2201 |
| Issuer | BLUE CROSS BLUE SHIELD LOCATION ID NUMBER |
| Number | 511-69544 |
| Name | Role |
|---|---|
| GOODWIN, JEREMY D | Agent |
| Name | Role |
|---|---|
| GOODWIN, JEREMY D | Organizer |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
